Primary gastrointestinal aspergillosis: a case report and literature review
Bahadir Ceylan1, Mesut Yilmaz1, Hüseyin Saffet Beköz2
1Medipol University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
Abstract:
Invasive aspergillosis is a severe infection that generally involves the lungs. Primary gastrointestinal aspergillosis is the least common form of invasive aspergillosis. A patient aged 65 years developed a febrile neutropenic episode following an autologous stem cell transplant for plasmacytoid variant diffuse large B-cell gastric non-Hodgkin's lymphoma. He had abdominal pain on the second day of the febrile neutropenic episode and ileus occurred on the sixth day. His general condition deteriorated despite broad spectrum antibiotics and caspofungin treatment, and intestinal perforation occurred on the nineteenth day of the febrile neutropenic episode. Pathological examination of the resected jejunum and ileum revealed mould hyphae compatible with aspergillus. The patient died due to massive gastrointestinal bleeding on the fifth post-operative day. Although a rare condition, primary gastrointestinal aspergillosis should be kept in mind while treating neutropenic patients with gastrointestinal symptoms.
Insights
Primary gastrointestinal aspergillosis is a rare but severe infection. This case highlights the importance of considering invasive aspergillosis in neutropenic patients with gastrointestinal symptoms.
Area of Science:
- Medical Mycology
- Gastroenterology
- Hematology
Background:
- Invasive aspergillosis typically affects the lungs, with primary gastrointestinal involvement being exceptionally rare.
- Patients undergoing autologous stem cell transplantation are at high risk for opportunistic infections due to profound neutropenia.
Observation:
- A 65-year-old patient developed febrile neutropenia post-stem cell transplant for gastric non-Hodgkin's lymphoma.
- The patient presented with abdominal pain and ileus, progressing despite empirical treatment.
- Intestinal perforation occurred, confirmed aspergillosis on pathological examination.
Findings:
- The patient experienced a severe, invasive gastrointestinal aspergillosis.
- Despite medical and surgical interventions, the patient succumbed to complications.
- Fungal hyphae consistent with Aspergillus were identified in resected intestinal tissue.
Implications:
- Early recognition of gastrointestinal aspergillosis is crucial in immunocompromised patients.
- This case underscores the need for high clinical suspicion for invasive fungal infections in neutropenic patients with GI distress.
- Prompt diagnosis and targeted antifungal therapy may improve outcomes for this rare condition.
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